Provider Demographics
NPI:1649457391
Name:CHRISTIAN, MELVIN L JR (CRNA)
Entity type:Individual
Prefix:
First Name:MELVIN
Middle Name:L
Last Name:CHRISTIAN
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4976 ALPHA LN
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5470
Mailing Address - Country:US
Mailing Address - Phone:423-497-5355
Mailing Address - Fax:423-308-0281
Practice Address - Street 1:1651 GUNBARREL RD STE 102
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3289
Practice Address - Country:US
Practice Address - Phone:423-308-0390
Practice Address - Fax:423-308-0393
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN013066367500000X
TNRN01157378163W00000X
INRN28188181A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN01308102OtherAMERIGROUP TENNCARE- NON PAR GCA
TN3600299Medicaid
TNP00836567OtherRR MEDICARE
TN4228707OtherBLUE CROSS/BLUE SHIELD OF TN - GCA
IN200975960Medicaid
TN103I437194Medicare PIN
TN4228707OtherBLUE CROSS/BLUE SHIELD OF TN - GCA